MEDICARE: THE EXCELLENCE GROUP, LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QH0100X	Health Service Clinic/Center	070012853	IL
2	261QP2000X	Physical Therapy Clinic/Center	070012853	IL

General Provider Information

NPI Number	:	1861815706
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	THE EXCELLENCE GROUP, LLC

Provider Business Mailing Address
First Line	:	1102 E 46TH ST
Second Line	:	SUITE 202
City	:	CHICAGO
State	:	IL
Zip	:	60653-4435
Country	:	US
Telephone Number	:	708-359-9899
Fax Number	:

Provider Business Practice Location Address
First Line	:	1102 E 46TH ST
Second Line	:	SUITE 202
City	:	CHICAGO
State	:	IL
Zip	:	60653-4435
Country	:	US
Telephone Number	:	708-359-9899
Fax Number	:

Authorized Official
Title or Position	:	OWNER/PHYSICAL THERAPIST
Name	:	MS. TEKELA R SCOTT
Credential	:	M.P.T
Telephone Number	:	708-359-9899

Provider Enumeration Date	:	01/29/2014
Last Update Date	:	01/29/2014

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Directions to “THE EXCELLENCE GROUP, LLC ” Practice Location

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